Healthcare Provider Details

I. General information

NPI: 1881738250
Provider Name (Legal Business Name): DANNIELE GOMES HOLANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 EXECUTIVE CENTER DR STE 100
LITTLE ROCK AR
72211-4386
US

IV. Provider business mailing address

10810 EXECUTIVE CENTER DR STE 100
LITTLE ROCK AR
72211-4386
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-2695
  • Fax:
Mailing address:
  • Phone: 501-604-2695
  • Fax: 501-604-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number39714
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: